Tues/Thurs. Exam 2 Review

Critical care services has 2 categories

1. critical care services 2. neonatal & pediatric critical care services.

in order to report a critical care code of 99291, a physician must spend at least ___minutes with a critically ill patient.

30

select the appropriate code for a new patient office visit in which a comprehensive history and comprehensive physical examination were performed and medical decision making was of straightforward complexity.

99202

which codes are used to report a consultation provided in the emergency department?

Consultations provided in the emergency department are reported with the office or other outpatient consultations codes 99241-99245.

Critical Care Services

Critical Care is the direct delivery by a physician or other qualified health care professional of medical care for a critically ill or critically injured patient. A critical illness or injury acutely impairs one or more vital organ systems such that there is a high probability of imminent or life threatening deterioration in the patient's condition. Critical care involves high complexity decision making to assess, manipulate, and support vital systems functions to treat single or multiple vital organ system failure and/or to prevent further life threatening deterioration of the patient's condition. Although, critical care typically requires interpretation of multiple physiologic parameters and/or application of advanced technology(s), critical care may be provided in life threatening situations when these elements are not present. Critical care may be provided in life threatening situations when these elements are not present. Critical care may be provided on multiple days, even if no changes are made in the treatment rendered to the patient, provided that the patient's condition continues to require the level of attention described above. Providing medical care to a critically ill, injured, or post-operative patient qualifies as a critical care service only if both the illness or injury and the treatment being provided meets the above requirements. Critical care is usually, but not always, given in a critical care area, such as the coronary care unit, intensive care unit, pediatric intensive care unit, respiratory care unit, or the emergency care facility.

for reporting of physician services, E/M codes are usually based on

Documentation of history, physical examination, and medical decision making.

there are 6 sections to cpt

E/M, laboratory/pathology, surgery, radiology, anesthesia, and medicine

Guidelines- Other Emergency Services

Emergency medical systems(EMS) emergency care, advanced life support. In two-way voice communication with ambulance or rescue personnel outside the hospital. Direction of the performance of necessary medical procedures includes but is not limited to: telemetry of cardiac rhythm; cardiac and/or pulmonary resuscitation; endotracheal or esophageal obturator airway intubation; administration of intravenous fluids and/or administration of intramuscular, intratracheal or subcutaneous drugs; and/or electrical conversion of arrhythmia.

what does the symbol a bullet point before a code in the cpt manual signify?

The code is new for this year.

Critical care codes

are not limited to be used only for services performed in a critical care area.

Examples of vital organ system failure include, but not limited to :

central nervous system failure, circulatory failure, shock, renal, hepatic, metabolic, and/or respiratory failure.

In cpt, the symbol with two arrows facing each other are used to indicate

changes in verbiage other than that in code descriptions; for example, changes in coding guidelines or parenthetical notes.

per cpt guidelines, a concise statement describing the symptoms, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient's words, is the definition of the

chief complaint

per cpt guidelines, a separate procedure is

considered to be an integral part of another, larger service.

critical care services

direct delivery by a physician(s) of medical care for a critically ill or critically injured patient.

which E/M codes are used to report services to patients in a facility that provides room, board, and other personal assistance services, generally on a long-term basis.

domiciliary, rest home, or custodial care services.

what is intraservice time

face-to-face time

per cpt guidelines, a presenting problem of moderate severity is one that

has a moderate risk of morbidity without treatment, a moderate risk of mortality without treatment, uncertain prognosis, or increased probability of functional impairment.

Name three components in selecting a level of E/M service.

history, examination, and medical decision making.

Code: 99292

is used to report additional blocks of time, up to 30 minutes each beyond the first 74 minutes.

Code: 99291

is used to report the first 30-74 minutes of critical care on a given date. It should be used only once per date even if the time spent by the individual is not continuous on that date. Critical care of less than 30 minutes total duration on a given date should be reported with the appropriate E/M code not a critical care code.

In order to be included in the cpt manual, a procedure must meet which of the following criteria

it must be commonly performed by many physicians across the country, and it must be consistent with contemporary medical practice.

Per cpt coding guidelines, a "complete" diagnostic ultrasound of the retroperitoneum includes at least the following organs:

kidneys, abdominal aorta, common iliac artery origins, inferior vena cava

which of the following are parts of medical decision making

number of possible diagnoses or management options that must be considered, amount or complexity of medical record, diagnostic tests, or other information that must be obtained , reviewed, and analyzed, risk of significant complications, morbidity, and/or mortality associated with the patient's presenting problem, the diagnostic procedures, and /or the management options.

AHIMA hospital has a "fast-track" department attached to the emergency dept. This area is staffed by emergency dept physicians on a rotating basis, treats minor problems, and is open from 5am until 8 pm. What codes should be used to report services rendered in this dept.

office or other outpatient services codes.

critical illness or injury

one that acutely impairs one or more vital organ system. A high probability of imminent or life threatening deterioration in the patients condition.

Pediatric Patient Transport

one who is 24 months or less

category II codes cover all of the following topics

patient management, therapeutic, preventive, or other interventions, and patient safety

the alphabetic index to cpt includes listings for

procedures/services, examinations/tests, anatomic sites,

Guideline: Other Nursing Facility Services

requires 3 key components: detailed interval history; comprehensive examination; mdm low to moderate complexity.

documentation in history of use of drugs, alcohol, and /or tobacco is considered part of the

social history

Dr. Smith sees a patient in consultation in the hospital at the request of Dr.Jones. he renders an opinion. he then takes over the management of a portion of the patient's care. What codes should Dr.Smith use to bill for his subsequent hospital visit?

subsequent hospital care codes.

what does the symbol of 1 triangle before a code in the cpt manual signify?

the code has been revised in some way this year.

the use of the term "for" followed by a diagnosis in cpt means that

the procedure can only be reported for that diagnosis

the following statement is true of cpt codes.

they are numeric

the symbol of a plus sign before a code in cpt means that

this code can never be reported alone, can never be reported first, and is an add-on code.

True or false. When the sole purpose of the telephone/ internet communication is to arrange a transfer of care or other face-to-face services, the code range 99444-99449 for interprofessional telephone/ internet consultations are not reported.

true

True or false? Category II codes may not be used as the first-listed cpt code when the patient is seen only for counseling.

true

Guidelines-new or established patient

used to report evaluation and management services provided in the emergency dept. No distinction is made between new and established patients in the ED. Time is not a descriptive component for the ED because ED services are typically provided on a variable intensity basis, often involving multiple encounters with several patients over an extended period of time. Therefore, it is often difficult for physicians to provide accurate estimates of the time spent face-to-face with the patient.

select the appropriate code for an established patient visit which a comprehensive history and expanded problem-focused physical examination were performed and medical decision making was of low complexity.,

99213

For several years, Dr.S has been treating a female patient for type 2 diabetes, hypertension, and obesity. Before her next appointment, blood work was performed to determine the status of her diabetes. The patient presents to the office, and Dr.S examines her for evidence of infection or circulatory problems. She then asks the patient about her compliance with the 1200 calorie diet she has been on for the past 6 months. After reviewing these findings, Dr.S indicates to the patient that she will have to begin using insulin, because her diabetes is not responding to the current treatment. The patient begins to sob uncontrollably. She tells Dr.S that this means she is going to die because her grandmother got gangrene from this kind of diabetes and died from it. After calming the patient, Dr.S explains that using insulin is not a death sentence. She discussed diet, insulin administration, and hypoglycemic reactions, as well as the symptoms of hypoglycemia. She instructs the patient regarding proper foot and skin care and stresses the importance of seeing her ophthalmologist regularly. She also refers the patient to a registered dietitian for instruction on nutrition management related to insulin. The patient is much calmer and feels that she will learn a lot from the booklets that Dr.S has given her to review. The total time Dr.S spent with the patient is 25 minutes, with 20 of those minutes spent providing counseling and/or coordination of care. Assign the appropriate E/M code for this encounter.

99214. More than 50% of the encounter was spent providing counseling and/or coordination of care. Therefore, the level of service may be selected using time as the key or controlling factor for this encounter. The level is selected based on the total time of the face-to-face physician-patient encounter.

The subsequent observation care codes are

99224-99226

If a patient is admitted to the hospital on October 23 and discharged on October 26, what is the appropriate E/M code to report for the October 26 discharge date?

99238- Hospital discharge day management, would be reported for this service.

Assign the appropriate E/M code for na outpatient office consultation in which the physician performed a detailed history, a comprehensive physical examination, and medical decision making of moderate complexity.

99243

A nursing facility patient develops an acute illness and is seen by her attending physician. He performs a detailed interval history and a detailed physical examination and performs medical decision making of moderate complexity. What code should the physician use to report these services?

99309

pediatric inpatient critical care, patient six months of age, first day. Code:

99471

Define new patient

A new patient is one who has not received any professional services from the physician/qualified health care professional, or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years. When advanced practice nurses and physician assistants are working with physicians they are considered as working in the exact same specialty and exact same subspecialty as the physicians.

cpt was developed and is maintained by

AMA

When reporting a level of E/M service from the initial hospital care subcategory, how many key components must be met or exceeded to qualify for a particular level of service?

All 3 key components must meet or exceed the stated requirements to qualify for a particular level of service.

Guideline: Subsequent Nursing Facility Care

All levels of subsequent nursing facility care include reviewing the medical record and reviewing the results of diagnostic studies and changes in the patient's status (like changes in history, physical condition, and response to management) since the last assessment by the physician or other qualified health are professional.

If an anticoagulant management service is provided for a period less than 60 continuous outpatient days, is it appropriate to report code 99363?

Any period less than 60 continuous outpatient days is not reported. If less than the specified minimum number of services per period is performed, it would not be appropriate to report the anticoagulant management service code 99363.

a listing of all current modifiers is found in which appendix of cpt

Appendix A

A list of codes describing procedures that are exempt from use with modifier 63, can be found in

Appendix F

which of the appendices would a neurologist's practice consult to determine the nerve conduction code to assign for a study of the suprascapular motor nerve to the

Appendix J

True

As indicated in the transitional care management services guidelines in the CPT code set, only 1 physician or qualified health care professional may report these services and only once per patient within 30 days of discharge.

A 22-year-old male, established patient came to the physician's office seeking information about the human immunodeficiency virus (HIV). He did not want an examination but said he wanted to learn all he could from "an expert" rather than from his friends. The physician's progress note stated the following: Patient came in asking to learn about HIV. He said he is not sure if what he hears on the street is true and has come here to learn the facts. He said he is not sexually active but may become sexually active in the near future. He said that he is heterosexual. HIV was discussed with the patient in terms of what it is, how it affects the immune system, how it is spread, how to decrease the chance of becoming infected, and safe sex techniques. Total length of time spent counseling the patient was 30 minutes.

Code 99214, Office or other outpatient visit, should be reported for this service. More that 50% of the encounter was spent providing counseling and/or coordination of care. Therefore, the level of service may be selected using time as the key or controlling factor for this encounter. The level is selected based upon the total time of the face-to-face physician-patient encounter.

Guidelines: Standby Services

Code 99360 is used to report physician or other qualified health care professional standby services that are requested by another individual and that involve prolonged attendance without direct (face-to-face) patient contact. Care or services may not be provided to other patients during this period. This code is not used to report time spent proctoring another individual. It is also not used if the period of standby ends with the perforamnce of a procedure, subject to a surgical package by the individual who was on standby. Code 99360 is used to report the total duration of time spent on a given date on standby. Standby service of less than 30 minutes total duration on a given date is not reported separately. Second and subsequent periods of standby beyond the first 30 minutes may be reported only if a full 30 minutes if standby was provided for each unit of service reported.

True

Code 99477 is reported for a neonate who requires intensive observation, frequent interventions, and other intensive care services.

Guideline: Prolonged Service Without Direct Patient Contact

Codes 99358 and 99359 are used when a prolonged service is provided that is neither face-to-face time in the office or outpatient setting, nor additional unit/floor time in the hospital or nursing facility setting during the same session of an evaluation and management service and is beyond the usual physician or other qualified health care professional service time. This service is to be reported in relation to other physician or other qualified health care professional services, including evaluation and management services at any level. This prolonged service may be reported on a different date than the primary service to which it is related. For example, extensive record review may relate to a previous evaluation and management service performed earlier and commences upon receipt of past records. However, it must relate to a service or patient where (face-to-face) patient care has occurred or will occur and relate to ongoing patient management. A typical time for the primary service need not be established within CPT code set. Codes 99358 and 99359 are used to report the total duration of non-face-to-face time spent by a physician or other qualified health care professional on a given date providing prolonged service, even if the time spent by the physician or qualified health care professional on that date is not continuous. Code 99358 is used to report the first hour of prolonged service on a given date regardless of the place of service. It should be used only once per date. Prolonged services of less than 30 minutes total duration on a given date is not separately reported. Code 99359 is used to report each additional 30 minutes beyond the first hour regardless of the place of service. It may also be used to report the final 15 to 30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported. Do not report 99358,99359 for time spent in care plan oversight services 99339, 99340, 99374-99380, anticoagulant management 99363, 99364, medical team conferences 99366-99368, online medical evaluations 99444, or other non-face-to-face services that have more specific codes and no upper time limit in the CPT code set. Codes 99358, 99359 may be reported when related to the other non-face-t0-face service codes that have a published maximum time (telephone services).

Guidelines- Nursing Facility Services

Codes are used to report evaluation and management services to patients in nursing facilities (AKA: skilled nursing facility, intermediate care facilities, or lont-term care facilities). These codes should also be used to report evaluation and management services provided to a patient in a psychiatric residential treatment center (a facility or a distinct part of a facility for psychiatric care, which provides a 24-hour therapeutically planned and professionally staffed group living and learning environment). If procedures such as medical psychotherapy are provided in addition to evaluation and management services, these should be reported in addition to the evaluation and management services provided. Nursing facilities that provide convalescent, rehabilitative, or long term care are required to conduct comprehensive, accurate, standardized, and reproducible assessments of each resident's functional capacity using a resident assessment instrument (RAI). All RAIs include the minimum data set (MDS), resident assessment protocols (RAPs), and utilization guidelines. The MDS is the primary screening and assessment tool; the RAPs trigger the identification of potential problems and provide guidelines for follow-up assessments. Physicians have a central role in assuring that all residents receive thorough assessments and that medical plans of care are instituted or revised to enhance or maintain the residents' physical and psychosocial functioning. This role includes providing input in the development of the MDS and a multi-disciplinary plan of care, as required by regulations pertaining to the care of nursing facility residents.

Which of the following services are included in care management services code (99487 & 99489): a)coordinating the care of other professionals and agencies; b)educating the patient or caregiver about the patient's condition; c) monitoring the care plan; d) all of the above.

D) all the above. Services may include establishing, implementing, revising, and monitoring the care plan; coordinating the care with other professionals and agencies; and educating the patient or caregiver about the patient's condition, care plan, and prognosis.

A physician makes a home visit to a 67-year-old established patient with hypertension and peripheral vascular disease. The patient is hemiplegic and has been homebound for 2 years after a stroke. The physician performs an expanded problem-focused interval history, a problem-focused examination, and straightforward medical decision making. Identify the appropriate category/subcategory of E/M code(s) and assign the appropriate level of service for this encounter.

Home Services: 99347- home visit for the evaluation and management of an established patient, is reported for this visit.

True

If an immunization is administered at the same visit as a preventive medicine service, then it would be appropriate to report the immunization code, the associated administration code, and the preventive medicine service.

Category- Domiciliary, Rest Home (eg, Assisted Living Facility), or Home Care Plan Oversight Services

Individual physician supervision of a patient in home, domiciliary or rest home requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patient status, review of related laboratory and other studies, communication including telephone calls for purposes of assessment or care decisions with health care professionals, family members, surrogate decision makers and/or key caregivers involved in patients care, integration of new information into the medical treatment plan and/or adjustment of medical therapy, within a calendar month.

A preterm infant is transported from the facility where he was born by a neonatologist to a receiving facility. The physician assumes primary responsibility for the neonate at the referring hospital and provides face-to-face critical care for a total duration of 105 minutes during the transport to the receiving hospital and ends when the receiving hospital accepts responsibility for the patient's care. What code(s) should be reported?

Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services: 99466- critical care face-to-face services, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or younger. First 30-74 minutes of hands-on care during transport; 99467- each additional 30 minutes (list separately in addition to code for primary; add-on)

A 2-month-old girl was seen in the emergency department because of difficulty breathing. The pediatrician admitted the patient on the same day to the pediatric intensive care unit and provided critical care services. How is this reported?

Inpatient Neonatal Intensive Care Services and Pediatric and Neonatal Critical Care Services: 99471- Inpatient Neonatal and Pediatric Critical Care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age.

Guidelines- Critical Care

Inpatient critical care services provided to infants 29 days through 71 months of age are reported with pediatric critical care codes. The pediatric critical care codes are reported as long as the infant/young child qualifies for critical care services during the hospital stay through 71 months of age. Inpatient critical care services provided to neonates 28 days or younger are reported with neonatal critical care codes. The neonatal critical care codes are reported as long as the neonate qualifies for critical care services during the hospital stay through the 28th postnatal day. The reporting of the pediatric and neonatal critical care services is not based on time or the type of unit and it is not dependent upon the type of physician or other qualified health care professional delivering the care. To report critical care services provided in the outpatient setting (ED or office etc.), for neonates and pediatric patients up through 71 months of age, see critical care codes 99291 and 99292. If the same individual provides critical care services for a neonatal or pediatric patient in both the outpatient the outpatient and inpatient settings on the same day, report only the appropriate neonatal or pediatric critical care code 99468-99472 for all critical care services provided on that day. Also report 99291-99292 for neonatal or pediatric critical care services provided by the individual providing critical care at one facility but transferring the patient to another facility. Critical care services provided by a second individual of a different specialty not reporting a per day neonatal or pediatric critical care code can be reported with codes 99291 and 99292. For additional instructions on reporting these services, see the neonatal and pediatric critical care section and codes 99468-99476. Services for a patient who is not critically ill but happens to be in a critical care unit are reported using other appropriate E/M codes. Critical care and other E/M services may be provided to the same patient on the same date by the same individual. For reporting by professionals, the following services are included in critical care when performed during the critical period by the physician(s) providing critical care: the interpretation of cardiac output measurements, chest x-rays, pulse oximetry, blood gases, and information data stored in computers (ECGS, blood pressures, hematologic data); gastric intubation; temporary transcutaneous pacing; ventilatory management; and vascular access procedures. Any services performed that are not included in this listing should be reported separately. Facilities may report the above services separately. Codes 99291 & 99292 should be reported for the attendance during the transport of critically ill or critically injured patients older than 24 months of age to or from a facility or hospital. For transport services of critically ill or critically injured pediatric patients older than 24 months of age or younger see 99466 & 99467. Codes 99291 & 99292 are used to report the total duration of time spent in provision of critical care services to a critically ill or injured patient, even if the time spent providing care on that date is not continuous. For any given period of time spent providing critical care services, the individual must devote his/her full attention to the patient and, therefore, cannot provide services to any other patient during the same period of time. Time spent with the individual patient should be recorded in the patient's record. The time that can be reported as critical care is the time spent engaged in work directly related to the individual patient's care whether that time was spent at the immediate bedside or elsewhere on the floor or unit. For example, time spent on the unit or at the nursing station on the floor reviewing test results or imaging studies, discussing the critically ill patient's care with other medical staff or documenting critical care services in the medical record would be reported as critical care, even though it does not occur at the bedside. Also, when the patient is unable or lacks capacity to participate in discussions, time spent on the floor or unit with family members or surrogate decision makers obtaining a medical history, reviewing the patient's condition or prognosis, or discussing treatment or limitation(s) of treatment may be reported as critical care, provided that the conversation bears directly on the management of the patient. No one can report remote real-time interactive video-conference critical care services (0188T, 0189T) for the period in which any other physician or qualified health care professional reports codes 99291 & 99292.

history, physical examination, and medical decision making are the ____components considered in assigning an E/M code.

Key

A 5-year-old boy presents to the office with scaly lesions on his right forearm. They have been present for only a week. His father, whom he sometimes visits, has both a cat and a dog. Within the scenario provided, identify the following elements fo the HPI: Location and Duration

Location: right forearm Duration: A week

Which of the following are considered components of the social history?

Occupational history, and marital history.

How is this encounter reported? At the initial office visit for a new patient, a 6-year-old boy with a 2-day history of lower abdominal pain with occasional vomiting, a detailed history is obtained including gastrointestinal system, fever, appetite, and characteristic of pain and bowel movements. A detailed examination of the chest and abdomen and rectal examination. Medical decision making is of low complexity. Appropriate laboratory studies are ordered and plans for surgical consultation are also initiated. Identify the appropriate category or subcategory of E/M services and assign the appropriate level of E/M code for this encounter.

Office or other outpatient services, new patient, level of service 99203.

a physician sees a patient in his office in the morning, then again in the early afternoon, at which time he sends the patient to the hospital and admits him as a full inpatient. what E/M code should be assigned for this day of care?

One code for the initial inpatient admission only.

Category- Nursing Facility Services

Subcategories- Initial Nursing Facility Care/ Subsequent Nursing Facility Care/ Nursing Facility Discharge Services/ Other Nursing Facility Services.

Category- Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services.

Subcategories- New Patient and Established Patient

Category- Prolonged Services

Subcategories- Prolonged Services with Direct Patient Contact/ Prolonged Services without Direct Contact/ Standby Services.

Category- emergency department services

Subcategories- new or established patient/ other emergency services.

Guideline: Domiciliary, Rest Home (eg, Boarding Home), or Custodial Care Services.

The following codes are used to report evaluation and management services in a facility which provides room, board, and other personal assistance services, generally on a long-term basis. They also are used to report evaluation and management services in an assisted living facility. The facility's services do not include a medical component.

Initial nursing facility care coding tip

The inclusion of time as an explicit factor beginning in cpt is done to assist in selecting the most appropriate level of E/M services. It should be recognized that the specific times expressed in the visit code descriptors are averages and , therefore, represent a range of times that may be higher or lower depending on actual clinical circumstances. Intraservice times are defined as face-to-face time for office and other outpatient visits and as unit/floor time for hospital and other inpatient visits. This distinction is necessary because most of the work of typical office visits takes place during the face-to-face time with the patient, while most of the work of typical hospital visit takes place during the time spent on the patient's floor or unit (hospital observation services, inpatient hospital care, initial inpatient hospital consultations, nursing facility). For reporting purposes, intraservice time for these services is defined as unit/floor time, which includes the time present on the patient's hospital unit and at the bedside rendering services for that patient. This includes the time to establish and/or review the patient's chart, examine the patient, write notes, and communicate with other professionals and the patient's family. In the hospital, pre- and post-time includes time spent off the patient's floor performing such tasks as reviewing pathology and radiology findings in another part of the hospital. This pre- and postvisit time is not included in the time component described in these codes. However, the pre- and post-work performed during the time spent off the floor or unit was included in calculating the total work of typical services in physician surveys. Thus, the unit/floor time associated with the services described by any code is a valid proxy for the total work done before, during, and after the visit.

Guideline: Nursing Facility Discharge Services

The nursing facility discharge day management codes are to be used to report the total duration of time spent by a physician or other qualified health care professional for the final nursing facility discharge of a patient. The codes include, as appropriate, final examination of the patient, discussion of the nursing facility stay, even if the time spent on that date is not continuous. Instructions are given for continuing care to all relevant caregivers, and preparation of discharge records, prescriptions, and referral forms.

Guidelines: Prolonged Services With Direct Patient Contact

These codes are used when a physician or other qualified health care professional provides prolonged services involving direct patient contact that is provided beyond the usual service in either the inpatient or outpatient setting. Direct patient contact is face-to-face and includes additional non-face-to-face on the patient's floor or unit in the hospital or nursing facility during the same session. This service is reported in addition to the designated evaluation and management services at any level and any other services provided at the same session as evaluation and management services. Appropriate codes should be selected for supplies provided or procedures performed in the care of the patient during this period. Codes 99354-99355 are used to report the total duration of face-to-face time spent by a physician or other qualified health care professional on a given date providing prolonged services in the office or other outpatient setting, even if the time spent by the physician or other qualified health care professional on that date is not continuous. Codes 99356 and 99357 are used to report total duration of time spent by a physician or other qualified health care professional at the bedside and on the patient's floor or unit in the hospital or nursing facility on a given date providing prolonged service to a patient, even if the time spent by the physician on that date is not continuous. Code 99354 or 99356 is used to report the first hour of prolonged service on a given date, depending on the place of service. Either code should be used only once per date, even if the time spent by the physician or other qualified health care professional is not continuous on that date. Prolonged services of less than 30 minutes total duration on a given date is not reported separately because the work involved is included in the total work of the evaluation and management codes. Code 99355 or 99357 is used to report each additional 30minutes beyond the first hour, depending on the place of service. Either code may also be used to report the final 15-30 minutes of prolonged service on a given date. Prolonged service of less than 15 minutes beyond the first hour or less 15 minutes beyond the final 30 minutes is not reported separately. The use of time based add-on codes requires that the primary evaluation and management service have a typical or specified time.

the following statements are about cpt category III codes

They were developed to reflect emerging technologies and procedures. They are archived after 5 years if the code has not been accepted for inclusion in the main body of cpt. Reimbursement for these services is dependent on individual payer policy.

A patient is referred by his physician to see an orthopedic surgeon for a consultative service. During the first visit with the orthopedic surgeon, the physician initiates diagnostic or therapeutic service. Upon completion of the visit, opinion or advice is rendered back. Would this encounter be considered a consultation?

This encounter may be reported with the consultation codes, as the physician consultant may initiate diagnostic and/or therapeutic services at the same or subsequent visit.

When counseling consumes more than half the total visit time, _____ may be used as the criterion for assigning the E/M code.

Time

Guideline: Initial Nursing Facility Care

When the patient is admitted to the nursing facility in the course of an encounter in another site of service(hospital emergency dept, office), all evaluation and management services provided by that physician in conjunction with that admission are considered part of the initial nursing facility care when performed on the same date as the admission or readmission. The nursing facility care level of service reported by the admitting physician should include the services related to the admission he/she provided in the other sites of services as well as in the nursing facility setting. Hospital discharge or observation discharge services performed on the same date of nursing facility admission or readmission may be reported separately. For a patient discharged from inpatient status on the same date of nursing facility admission or readmission, the hospital discharge services should be reported with codes 99238 and 99239 as appropriate. For a patient discharged from observation status on the same date of nursing facility admission or readmission, the observation care discharge services should be reported with code 99217. For a patient admitted and discharged from observation or inpatient status on the same date see codes 99234- 99236.

During the performance of a femoral angioplasty, a patient develops additional areas of occlusion. A diagnostic angiogram of the affected artery is performed. Is it appropriate to code this diagnostic study in addition to the therapeutic procedure?

Yes. Per revised coding guidelines, if there is a clinical change during an interventional procedure that requires further diagnostic study, the diagnostic angiogram may be reported in addition to the therapeutic procedure.

observation E/M codes (99218-99220) are used when

a patient is placed in designated observation status.

Consultation

a type of service provided by a physician whose opinion or advice regarding evaluation and /or management of a specific problem is requested by another physician or other appropriate source.

preventive medicine services are based on the following criteria

age of the patient

Emergency Department

an organized hospital-based facility for the provision of unscheduled episodic services to patients who presents for immediate medical attention.

if a surgeons performs a procedure for which there is no cpt code and no hcpcs level II code, what code should be reported on the CMS 1500 form?

an unlisted procedure code from the appropriate chapter of cpt.

cpt is updated

annually for the main body of codes and every 6 months for category III codes.

the codes in the musculoskeletal section of cpt may be used by

any physician

Non-pediatric patients transport

anyone over the age of 5.

Definition for critical care services

apply for adult, child, and neonate.